Autistics, ADHD, & Addictions: A Broader View

Why we are at higher risk for substance use issues

Created by author on Canva

I was on a roll

I originally wrote this piece in January after publishing a review of Dr. Maté’s new book, The Myth of Normal, in which I decry the fact that he completely ignores the Autistic and ADHD populations when discussing addictions.

In true AuDHD fashion, this led me down a separate rabbit hole, exploring the underlying factors contributing to increased rates of addiction in Autistics and ADHDers.

The research focuses primarily on the neurological processes and executive functioning challenges which may contribute to addictions risk, such as impulsivity, dopamine “deficiency” (an inaccurate term), and genetics.

Although in the end, I personally would not recommend Dr. Maté’s new book, I did highlight a strength of his, which is his ability to look at the bigger picture when it comes to understanding and treating addictions and illnesses.

So I will write the section I felt was missing from his book here.

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Prevalence

Largely due to an inaccurate stereotype of Autistics being “innocent” and unlikely to engage in risky sex, drug use, or alcohol use, there is inadequate research on the prevalence rates of substance use disorders (SUD) in Autistics.

One study suggests as many as 36% of Autistics may have a co-occurring issue with substance abuse, compared to a global estimate of just over 2%. In those with ADHD, the lifetime prevalence of addictions is estimated to be 12% for alcohol use disorders and 28% for drug use disorders.

Even countries with the highest rates of SUD have an estimated prevalence of between 5–6%, those being in Eastern Europe (Russia, Kazakhstan, Mongolia) and North America (USA and Canada).

Autistics may use alcohol or other drugs to mask social anxiety or to self-medicate against underlying psychological distress.

ADHDers are also more likely to self-medicate, either as a form of sensation-seeking due to reduced dopamine availability in the brain or in attempts to numb emotional pain.

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Masking & self-medicating

Masking is attempting to suppress or hide traits which make us seem different. It’s also sometimes referred to as camouflaging, as we try to “blend in” with the neurotypical majority.

Masking can happen unconsciously, as we are gradually conditioned to follow certain social expectations in order to avoid criticism and rejection. It can also be a conscious decision, especially as we become more self-aware, when we mask as an act of self-preservation.

While masking is something we do to avoid negative social consequences, masking itself also has significant risks, especially when done over the long-term. Potential harms of masking include increased anxiety, fatigue, burnout, depression, isolation, feeling disconnected from oneself, and suicidal ideation.

Research has shown the primary reasons Autistics drink alcohol are to quell social anxiety and sensory processing challenges.

Autistics are also at higher risk for co-occurring anxiety, depression, bipolar and mood disorders, schizophrenia, suicidal behavior disorders, and ADHD.

No wonder we are more likely to self-medicate with mood-altering substances.

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Social factors